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CLINICAL AND ANAMNESIS FACTORS AFFECTING THE COURSE OF ATHEROSCLEROSIS PERIPHERAL ARTERIES OF THE LOWER EXTREMITIES

Аuthors: E. D. Yarovaya

Pages: 768–778

Abstract

         

Introduction. Atherosclerosis of peripheral arteries of the lower extremities (PAD) is an independent predictor of increased risk of cardiovascular complications, which determines the quality and length of life.

The purpose of research: to examine the role of clinical and anamnestic indicators of atherosclerosis in peripheral arteries of the lower extremities.

Materials and Methods. The study involved 100 men with PAD of average age 60.7 ± 0.9 years IIA–IV stages of lower limb ischemia. Besides clinical tests, we performed determination of glomerular filtration rate (GFR), ankle-brachial index, selective coronary angiography (SCG), Doppler ultrasound of the lower extremities and carotid arteries (CA) with the estimation of intima-media thickness (IMT), echocardiography, Holter monitoring.

Results and discussion. A group of hypertension (55 patients) had more abuse diastolic function of left ventricular (p = 0.038), signs of left ventricular hypertrophy (p = 0.001). Among patients with type 2 diabetes (28 patients), there is a higher incidence of heredity burdened by CVD (p = 0.02), coronary artery disease (p = 0.006), recurrent myocardial infarction (MI) (p = 0.02). Group DL patients (73 patients) had a higher incidence of recurrent myocardial infarction (p = 0.02), more frequently were observed two vascular coronary arteries during the SCG (p = 0.02). Patients with a family history for CVD (60 patients) had a higher incidence of critical ischemia of the lower limbs (p = 0.005) and type 2 diabetes (p = 0.02). Patients with obesity (42 patients) had a greater frequency of left ventricular hypertrophy (p = 0.02) and a lower prevalence of hypertension (p = 0.037). At patients with CVA (13 patients) was found a higher functional class of angina pectoris (p = 0.009). At patients with coronary artery disease was detected (37 patients): the average age of the manifestation of PAD was significantly lower (p = 0.001), more higher IMT (p = 0.003) and higher frequency of CA atherosclerosis (p = 0.0002), GFR was significantly lower (p = 0.004), the probability of decline in renal function – 72 % (p = 0.0043); it was independent direct association with the CA atherosclerosis (p = 0.05) and inverse association with patient’s age (p = 0.01).

Conclusions.

1. The presence of a family history for CVD among PAD patients is associated with a higher degree of ischemic lesions of arteries of the lower extremities (p = 0.005) and registration of type 2 diabetes (p=0.02), which is prognostically adverse cardiovascular events and is connected with coronary artery disease (p = 0.006).

2. The incidence of CHD among PAD patients is associated with early manifestation of PAD (p = 0.001), more severe clinical manifestations of lower limb ischemia (p = 0.02), carotid disease (p = 0.0002) and reduced GFR (p = 0.021). This recurrent MI was associated with dyslipidemia (p = 0.02) and type 2 diabetes (p = 0.02).

Keywords: peripheral artery disease, ischemic heart disease, cardiovascular risk.

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